Comparing outcomes following open, hybrid, minimally invasive, and robotic-assisted esophagectomy: a systematic review
A partir d'une revue systématique de la littérature (16 essais randomisés incluant au total 2 729 patients atteints d'un cancer de l'oesophage), cette étude compare les résultats périopératoires et à long terme de 4 types d'oesophagectomies (ouverte, hybride, mini-invasive et robot-assistée)
Background: Esophagectomy remains the standard of care for patients with resectable locally advanced malignancies of the oesophagus.
Aim: To compare perioperative and long-term outcomes across open (OE), hybrid (HE), minimally invasive (LMIE), and robotic-assisted esophagectomy (RAMIE) for esophageal pathologies using randomised controlled trial (RCT) data.
Methods: A systematic search of the EMBASE, SCOPUS and PUBMED databases was performed to identify RCTs comparing OE, HE, LMIE and RAMIE. Descriptive statistics were performed using SPSS v26.0.
Results: Sixteen RCTs with 2,729 total patients were included. Overall, 50.6% of patients underwent OE (1,381/2,729), 5.4% underwent HE (148/2,729), 31.4% underwent LMIE (856/2,729) and 12.6% underwent RAMIE (344/2,729). LMIE and RAMIE demonstrated reduced pulmonary complications and hospital stay compared with OE. RAMIE achieved superior lymph node dissection rates, compared to LMIE. HE demonstrated lower complication rates than OE, with comparable lymph node yields. In-hospital mortality remained low across all groups, with no significant differences, though LMIE and RAMIE had demonstrated better short-term recovery. Meta-analysis of 9 RCTs showed higher 30-day mortality with OE compared to MI (RR 1.84, 95% CI 1.02–3.34; I2 = 0%). Long-term survival and disease-free survival rates were largely comparable across all techniques. Quality of life (QOL) metrics one year post-surgery indicated that LMIE and RAMIE provided better physical functioning, pain reduction, and social functioning than OE.
Conclusion: LMIE and RAMIE were superior in terms of blood loss, pulmonary complications, hospital stays, improved QOL, and lymph node yield compared to OE. Notwithstanding these concerted benefits, equipoise was demonstrated in terms of rates of surgical site infection, chyle leak, mortality, survival and oncological outcomes. Thus, minimally invasive techniques should be considered where surgeon and institution expertise allow.
European Journal of Surgical Oncology , résumé, 2025